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Abstrak :
ABSTRAK
Pleural effusion occurs when abnormal pleural fluid accumulate within pleural cavity. The first step in pleural effusion evaluation is categorising pleural fluids into transudates and exudates using Light rsquo s Criteria, to determine differential diagnoses. Transudative pleural effusions occur when systemic factors influencing hydrostatic and oncotic pressures are imbalanced. Exudative pleural effusions occur due to local factors influencing increased vascular permeability. This research aims to describe profiles of pleural fluid analysed by Department of Clinical Pathology, Dr. Cipto Mangunkusumo National General Hospital RSCM and investigate their diagnostic value.Data were collected between January August 2016 consecutively. In total, 199 pleural fluids were assessed 123 exudative, 72 transudative and 4 transudative exudative transitional pleural fluids. The samples comprised of 56.3 females and 43.2 males. The age ranged from 1 month to 83 years old, averaging at 45.3 years old. Malignancy was the most frequent etiology found 35.7 , followed by Infection 22.1 . Pleural fluids were predominantly yellow 51.7 . Compared to transudates, exudates were more likely to clot, mostly tested positive for Rivalta and appeared more turbid. WBC count, protein fluid, protein ratio, LDH fluid and LDH ratio of exudates were significantly higher than transudates. Exudates exhibited significantly lower glucose fluid levels. Bacteriologically, 13 samples yielded a positive culture.Profiles of transudative and exudative pleural fluids correlated with their respective clinical conditions, reflecting different underlying mechanisms, thus verifying Light rsquo s criteria. Diagnostic values of pleural fluid analyses towards its clinical diagnosis yielded Sensitivity of 66.7 , Specificity of 67.9 , Positive Predictive Value of 90.6 and Negative Predictive Value of 27.1.

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ABSTRAK
Pada Pleura Effusi terdapat akumulasi cairan pleura abnormal pada rongga pleura. Langkah pertama pada algoritme pleura effusi adalah kategorisasi cairan pleura menjadi transudat dan eksudat untuk menentukan diagnosis differensial. Cairan pleura transudat ditemukan pada etiologi sistemik dimana terdapat ketidakseimbangan tekanan hidrostatik dan onkotik. Cairan pleura eksudat ditemukan pada etiologi lokal dimana terdapat peningkatan permeabilitas. Cairan transudat dan eksudat dapat dibedakan menggunakan kriteria Light rsquo;s. Penelitian ini bertujuan untuk mendeskripsikan profil analisis cairan pleura di Departemen Patologi Klinik, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo RSCM dan untuk menginvestigasi nilai diagnostik analisis cairan pleura.Penelitian ini menggunakan sampel cairan pleura dari Departemen Patologi Klinik yang dipilih antara bulan Januari-Agustus 2016 secara konsekutif. Sampel berjumlah 199; 72 transudat, 127 eksudat dan 4 peralihan transudate ke eksudat. Demografik sampel adalah 56.3 perempuan dan 43.2 laki-laki. Umur berkisar antara 1 bulan-83 tahun dan rerata 45.3 tahun. Etiologi paling sering adalah keganasan 35.7 , diikuti dengan infeksi 22.1 . Dibandingkan dengan transudat, eksudat lebih banyak terdapat bekuan, hasil Rivalta positif dan lebih keruh. Leukosit, protein cairan, protein rasio, LDH cairan dan LDH rasio lebih tinggi pada eksudat. Glukosa cairan lebih rendah pada eksudat. 13 sampel menunjukkan kultur positif.Terdapat korelasi antara profil cairan pleura transudat dan eksudat dengan diagnosis klinis, menunjukkan adanya perbedaan mekanisme dan menggambarkan efektifitas kriteria Light rsquo;s. Nilai diagnostik analisis cairan pleura berupa sensitivitas 66.7 , spesifisitas 67.9 , nilai prediksi positif 90.6 dan nilai prediksi negatif 27.1

Abstrak :
ABSTRAK Latar Belakang. Salah satu penyakit jantung bawaan (PJB) yang kompleks adalah terdapatnya satu ventrikel yang fungsional. Tatalaksana yang dilakukan untuk kelainan ini adalah dengan operasi Fontan. Efusi pleura merupakan salah satu komplikasi yang sering terjadi setelah operasi Fontan. Peningkatan tekanan akhir diastolik ventrikel sistemik (TADVS) sebelum operasi diduga turut berperan dalam terjadinya efusi pleura paska operasi Fontan. Metode. Studi potong lintang dilakukan terhadap populasi yang sudah dilakukan operasi Fontan dengan ekstrakardiak konduit dan fenestrasi di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) periode April 2006 sampai dengan April 2016. Durasi efusi pleura berdasarkan pada lama terpasangnya selang (drain) intrapleura setelah operasi Fontan. Lama rawat adalah lama rawat setelah operasi Fontan. Data studi diambil dari rekam medik. Hasil. Populasi studi penelitian sebanyak 63 pasien dengan nilai rerata TADVS adalah 9,7 mmHg dengan standar deviasi ± 2,8 mmHg. Efusi pleura terjadi pada semua pasien dengan nilai tengah 9 hari (2-54 hari), dengan 43 pasien (68,3%) yang > 7 hari. Nilai tengah lama rawat adalah 20 hari (8-58 hari). Uji korelasi Spearman menunjukkan tidak terdapat korelasi bermakna antara TADVS dengan lama efusi pleura sesudah operasi (p = 0,548, r = -0,077) dan lama rawat (p = 0,843, r = -0,025). Analisis bivariat menunjukkan 2 variabel yang mempunyai korelasi bermakna terhadap lama efusi pleura yaitu dominan ventrikel kanan (p = 0,014) dan waktu CPB (p = 0,003), kemudian terdapat 5 variabel berkorelasi bermakna terhadap lama rawat yaitu waktu CPB (p = 0,023), aritmia sesudah operasi (p = 0,021), lama aritmia sesudah operasi (p = 0,009), infeksi sesudah operasi (p = 0,000), kadar albumin sesudah operasi (p = 0,005) dan lama efusi pleura sesudah operasi (p = 0,000). Kesimpulan. Tidak terdapat korelasi bermakna antara TADVS sebelum operasi Fontan dengan lama efusi pleura sesudah operasi dan lama rawat.

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ABSTRACT Background: Congenital Heart Disease (CHD) is a major congenital disease. One of the most common is a CHD that only have single functional ventricle. Management for this disease is Fontan operation. Pleural effusion is one of the most common complication after operation. Elevated systemic ventricle end diastolic pressure (SVEDP) will increase pulmonary vein pressure, pulmonary artery pressure, and pleural vein pressure consecutively that leads to pleural effusion. Goals: To correlate between SVEDP before Fontan operation with post operative pleural effusion duration and length of stay. Methods: Cross sectional study was performed to patients who underwent Fontan operation extra cardiac conduit and fenestration at National Cardiac Centre Harapan Kita (NCCHK) from April 2006 to April 2016. Pleural effusion duration was based on chest tube indwelling time after operation. Length of stay was days the patient hospitalized after operation. Baseline characteristic of the patients were obtained from medical records. Results: Subjects were 63 patients who fulfilled the criteria. Mean SVEDP was 9.7 mmHg with standard deviation of ± 2.8 mmHg. Pleural effusion occurred to all subjects ranged 2-54 days (median 9 days), in which 43 patients (68.9%) more than 7 days. Length of stay after operation ranged 8-58 days (median 20 days). Spearman correlation test showed no correlation between SVEDP with post operative pleural effusion duration (p = 0.548, r = -0.077) and length of stay (p = 0.843, r = -0.025). Bivariate analysis showed correlation between right ventricle domination and CPB time to pleural effusion duration with p = 0.014 and p = 0.003 respectively, whereas factors that correlate to length of stay after operation were CPB time (p = 0.023), post operative arrhythmia (p = 0.021), post operative arrhythmia duration (p = 0.009), post operative infection (p = 0.000), post operative albumin level (p = 0.005) and post operative pleural effusion duration (p = 0.000). Conclusions: There is no correlation between SVEDP before Fontan operation with post operative pleural effusion duration and length of stay.

Abstrak :
Latar Belakang : Efusi pleura merupakan salah satu komplikasi dari kanker atau penyakit keganasan yang sering terjadi. Efusi pleura maligna termasuk dalam 15% sampai dengan 35% dari seluruh kejadian efusi pleura dan angka kejadiannya mencapai 660 orang per 1 juta populasi secara global. Beberapa model prediksi telah dievaluasi untuk memprediksi mortalitas pada pasien efusi pleura maligna. Skor PROMISE merupakan sebuah model prediksi mortalitas 3 bulan pada pasien dengan efusi pleura maligna. Tujuan : Penelitian ini bertujuan untuk mengevaluasi performa kalibrasi dan diskriminasi skor Clinical PROMISE dalam memprediksi mortalitas tiga bulan pada pasien efusi pleura maligna. Metode : Penelitian ini menggunakan metode kohort retrospektif yang melibatkan pasien efusi pleura maligna yang terdaftar tahun 2015-2022 di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo. Dilakukan penilaian mortalitas tiga bulan. Data terkumpul dianalisis dengan uji Hosmer-Lemeshow goodness-of-fit untuk mengetahui performa kalibrasi dan pembuatan kurva Receiver Operating Curve (ROC) untuk mengetahui performa diskriminasi skor Clinical PROMISE terhadap luaran mortalitas tiga bulan. Hasil : Diperoleh 120 subjek yang disertakan dalam penelitian dengan proporsi mortalitas 60,8%. Mayoritas subjek adalah perempuan (73,3%), rerata usia 55 tahun, kanker tipe lain (78,3%). Skor Clinical PROMISE memiliki performa kalibrasi yang baik (p = 0,230, koefisien korelasi r = 0,945). Performa diskriminasi skor Clinical PROMISE baik dengan AUC 0,849 (IK95% 0,776 –0,922). Kesimpulan : Performa kalibrasi dan diskriminasi skor Clinical PROMISE dalam memprediksi mortalitas tiga bulan pada pasien efusi pleura maligna adalah baik. ......Background : Pleural effusion is a frequent complication of cancer or malignant disease. Malignant pleural effusion accounts for 15% to 35% of all pleural effusion cases and the incidence rate reaches 660 people per 1 million population globally. Several prediction models have been evaluated to predict mortality in malignant pleural effusion patients. The PROMISE score is a prediction model for 3-month mortality in patients with malignant pleural effusion. Aim : This study aims to evaluate the calibration and discrimination performance of the Clinical PROMISE score to predict three-month mortality in malignant pleural effusion patients. Methods : This study used a retrospective cohort method involving malignant pleural effusion patients registered in 2015-2022 at Dokter Cipto Mangunkusumo National Central General Hospital. A three-month mortality assessment was carried out. The collected data was analyzed using the Hosmer-Lemeshow goodness-of-fit test to determine the calibration performance and creation of a Receiver Operating Curve (ROC) curve to determine the discrimination performance of the Clinical PROMISE score on three-month mortality outcomes. Results : There were 120 included in the study with the proportion of mortality as high as 60.8%. The majority of subjects were women (73.3%), mean age 55 years, other types of cancer (78.3%). The Clinical PROMISE score had good calibration performance (p = 0.230, coefficient of correlation r = 0.945). The discrimination performance of the Clinical PROMISE score was good with an AUC of 0.849 (95% CI 0.776 –0.922). Conclusion : The calibration and discrimination performance of Clinical PROMISE score ini prediction 3-month mortality of malignant pleural effusion is good.

Abstrak :
ABSTRAK
Pleural effusion is a condition when there is an accumulation of fluid in pleural space. The condition may manifest in breathing impariment by limiting lung expansion space. Pleural effusion is suffered by more than 1.5 million people per year in America. A study held ini Persahabatan Hospital between 2010-2011 found 119 cases of pleural effusion, 42,8% was malignant pleural effusion. Pleural malignancy is the most common indication for thoracocentesis, thus must be considered in massive pleural effusion (MPE). Theraphy for MPE is palliative with the goal being relief of dyspnea. Treatment option for MPA are deteminded by several factors: symptoms and performance status of the patient, the primary tumor type and its response to systematic therapy, and degree of lung re-expansion following pleural fluid removal. In this case, we will present a case of malignant pleural effusion as an illustration in searching of evidence in comparing between pleurodesis and indwelling pleural catheter in management of malignant pleural effusion.

Abstrak :
Efusi pleura merupakan kejadian akumulasi cairan yang berada diantara lapisan parietal dan visceral. Efusi pleura terjadi akibat akumulasi cairan dimana pembentukan cairan pleura yang lebih cepat dibandingkan proses penyerapannya. Dyspnea merupakan pengalaman subjektif pasien tentang ketidaknyamanan saat bernapas dengan kualitas pernapasan ringan, sedang dan berat. Positioning yang tepat dapat memperbaiki proses ventilasi dapat meningkatkan ekspansi paru sehingga mengurangi sesak yang dialami oleh pasien. Tujuan : studi ini untuk menganalisis intervensi keperawatan mandiri berupa pengaturan posisi semi-fowler pada pasien dengan masalah pola napas tidak efektif pada kasus efusi pleura. Metode : yang digunakan adalah studi literatur terkait pemberian posisi semi-fowler pada pasien yang memiliki masalah pernapasan. Penerapan posisi semi-fowler merupakan posisi yang direkomendasikan untuk pasien efusi pleura dengan alat ukur MRC Dyspnoea scale. Asuhan keperawatan diberikan kepada pasien kelolaan yaitu Ny. A (60 tahun) dengan Efusi Pleura dan gagal jantung. Asuhan keperawatan dilakukan selama empat hari dengan satu hari periode IGD dan ICCU serta tiga hari pada periode ICCU. Masalah keperawatan utama yang dialami pasien adalah pola nafas tidak efektif. Implementasi dilakukan sesuai dengan rencana keperawatan, termasuk penerapan posisi semi-fowler. Hasil : studi menunjukan pemberian posisi semifowler berdampak pada peningkatan saturasi oksigen dan penurunan frekuensi napas pada kondisi sesak dengan alat ukur MRC Dyspnoea scale. Analisis studi ini merekomendasikan pengaturan posisi semi-fowler efektif untuk diimplementasikan pada pasien dengan masalah pola napas tidak efektif. ...... Pleural effusion is an accumulation of fluid between the parietal and visceral layers. Pleural effusion occurs due to fluid accumulation where the formation of pleural fluid is faster than the absorption process. Dyspnea is the patient's subjective experience of discomfort when breathing with mild, moderate and severe respiratory qualities. Positioning The right one can improve the ventilation process can increase lung expansion thereby reducing shortness of breath experienced by patient. Objective : this study was to analyze the intervention Independent nursing in the form of positioning semi-fowler in patients with problems with ineffective breathing patterns in cases of pleural effusion. Method : Which used is a literature study related to position assignment semi-fowler on patients who have respiratory problems.Application of position semi-fowler is the recommended position for pleural effusion patients with measuring instruments MRC Dyspnoea scale. Nursing care given to the managed patient, namely Mrs. A (60 years old) with Pleural Effusion and heart failure. Nursing care is provided for four days with one day during the ER and ICCU period and three days during the ICCU period. The main nursing problem experienced by patients is ineffective breathing patterns. Implementation is carried out in accordance with the nursing plan, including position implementation semi-fowler. Results: studies show position assignment semi-fowler has an impact on increasing oxygen saturation and a decrease in respiratory frequency in shortness of breath with measuring instruments MRC Dyspnoea scale. The analysis of this study recommends positioning semi-fowler effective to implement in patients with breathing pattern problems effective.

Abstrak :
Serous (peritoneal, pleural and pericardial) effusions are a frequently encountered clinical finding in everyday medical practice and one of the most common specimen types submitted for cytological evaluation. The correct diagnosis of effusions is critical for patient management, as well as for prognostication and yet many clinicians find diagnosis and treatment of cancer cells in effusions very challenging. Featuring multiple microscopic illustrations of all diagnostic entities and ancillary techniques (immunhistochemistry and molecular methods), this book provides a comprehensive, authoritative guide to all aspects of serous effusions, including etiology, morphology and ancillary diagnostic methods, as well as data related to therapeutic approaches and prognostication. Section one covers diagnosis for benign and malignant effusions including the etiological reasons for the accumulation of effusions that provides the reader with the full spectrum of differential diagnoses at this anatomic site. Section Two discusses biology, therapy and prognosis highlighting clinical approaches that may be of value to patients and the movement towards personalized medicine and targeted therapy.